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11-18-2009, 07:46 PM
Respiratory Complciations
a- Atelectasis
Occurs to some degree after all operations. It may be a cause of postoperative fever. It is caused by bronchial mucus plugs and extrinsic compression from hemopneumothorax, alveolar hypoventilation due to shallow breathing is more common.
b- Pneumonia
Usually a nosocomial infection. Risk factors include:
1- Old age.
2- Presence of underlying pulmonary or cardiovascular disease.
3- Cigarette smoking.
4- Long preoperative hospitalization.
5- Thoracic or upper abdominal incisions
6- Immunosuppressive therpay.
7- The necessity for prolonged ventilatory support.
c- Acute Respiratory Insufficiency
Definition: Either failure of the patient to meet acceptable criteria for extubation following operation or the urgent necessity for reintubation with resumption of ventilator support.
Indications for urgent reintubation include:
F Respiratory rate greater than 30 to 40 breaths per minute
F Low tidal volume of less than 300 ml per breath.
F PCO2 is greater than 50 mm Hg range.
F Arterial blood hypoxia with PO2 of less than 65 mm Hg.
d- Adult Respiratory Distress Syndrome:
Aetiology: Massive trauma, shock from any cause, intracranial injury, burns, sepsis, pancreatitis, long-bone fractrues, multiple transfusions.
Pathogenesis: Increased arterio-venous shunting causes hypoxemia, and bilateral pulmonary infiltration invariably develops. Endothelial and alveolar membrane injury causes accumulation of fluid and protein in the alveolar air space, severe pulmonary edema, and the development of hyaline membranes.
Clinical manifestations are satisfactory pulmonary function in the immediate postoperative period, with later development of tachypnea, anxiety, breathing fatigue.
Pulmaonry function studies reaveal decrease in compliance functional residual capacity.
The treatment of ARDS requires mechanical ventilation with positive end-expiratory pressure (PEEP). The use of diuretics may be warranted to reduce pulmoanry edema, and patients with renal failure may benefit from urgent dialysis. The use of PEEP decreasing the risk of pulmonary fibrosis due to oxygen toxicity.
Complications of positive-pressure ventilation include alveolar rupture with development of pneumothorax, pneumomediastinum, and pneumoperitoneum. Consequently frequent auscultation of the chest, serial chest X-ray, and monitoring of cardiac output is necessary for all patients being ventilated with positive airway pressure.
SOURCE: DR. AYMAN SALEM'S BOOK
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